The 1800s in America were an era of tremendous change. An industrial revolution ignited the country, while Civil War divided the nation. During this time, the mentally ill were cared for mostly in private homes and poorhouses. As populations increased, this was becoming impractical. State legislators pushed for a state-operated hospital to care for and provide treatment for the mentally ill.
In 1821, state legislation passed to finance a state hospital for the insane. The hospital admitted its first patient in 1828. Typically, patients who were wealthy enough to pay for their own care were admitted. A few African-Americans, mostly slaves, were admitted during the first 20 years. The state hospital included rooms that face south to provide fresh air, hidden hinges and locks to provide a less prison-like feel, also being one of the first fireproof structures in the United States.
By the 1850s, the average patient paid $250 annually. A separate eating area cost another $100. The indigent were admitted for an annual fee of $135, which was billed to the patient’s local government. As more poor people were admitted, the fees became harder to collect, and the asylum depended more on state funding.
During the Civil War, funding significantly decreased. The superintendent opposed turning the campus into a prisoner-of-war camp. Although the Confederate Army did not get the asylum, the grounds were used as a prison camp for Union troops from October 1864 to February 1865. When Union General William T. Sherman occupied the city, residents fled to the asylum for refuge. The superintendent opened the doors and allowed residents to seek refuge, even using his own funds to provide them with food and other necessities.
The architects who designed and constructed each section of the building modeled it off of Dr. Thomas Kirkbride’s system. Dr. Kirkbride was an influential doctor from Pennsylvania, who designed multiple institutions. His “Kirkbride System” consisted of repeated blocks linked together on each side of a central administration building, as well as open gardens, plenty of windows, gas lighting, segregation by gender, and no subterranean patient housing.
Originally, men and women were housed on different floors, later in separate buildings. When the second hospital was completed in 1858, male patients were moved in. Each wing was four stories with rooms split up into manageable wards. The oldest portions of the building are the north and south wings. The north wing housed male patients, and female patients were housed in the south wing.
Even with the second hospital building, the facility reached capacity of 192 patients by 1860. Many families preferred to care for their mentally ill relatives at home, or even in the county jail as opposed to the state hospital. Only after the state assumed direct responsibility for mentally ill patients in 1871, did the county jails readily transfer the patients to the state hospital. By 1900, the asylum’s population ballooned to over 1000. Sadly, 30% of the patient population died each year.
During the early 1900s, thousands of Americans were becoming sick and dying of a mysterious disease known as pellagra. The symptoms of pellagra included diarrhea, skin diseases, depression, seizures, and dementia. Many sufferers of this disease found themselves in these state-operated asylums, becoming a convenient place to warehouse people. Due to overcrowding, conditions were beyond deplorable and patient care was nonexistent.
By 1914, asylum physicians had determined the cause to be a vitamin b3 or niacin deficiency. A coalition of asylum superintendents from all over the United States along with local health officials organized several meetings here to discuss the infectious disease. One doctor hypothesized poverty was part of the problem, and malnutrition could be directly linked to the disease. Other physicians were skeptical that germs did not play a more significant role.
To prove his theory, the doctor orchestrated “filth parties” where he, along with his wife and assistants, injected themselves with blood, ingested scabs, bodily fluids, and feces of patients. No one developed pellagra. He also did decisive experiments with Mississippi prison inmates, who volunteered in exchange for a full pardon. The doctor fed the inmates a poor diet and within a few months, many of them developed the disease. He then added fresh vegetables, meats, and milk to their diet and reversed all of the signs and symptoms of pellagra.
The 20th century brought significant change to the state hospital. The superintendent realized the need for community health clinics. He pushed for programs to educate the public about mental illness, including its causes and methods of care. The first permanent outpatient clinic in the city opened in 1923. The success of the clinic inspired the opening of travel clinics that went throughout the state.
During the 1950s, the discovery of phenothiazine controlled many of the symptoms of mental illness, allowing the wards to be unlocked and patients to roam more freely. The introduction of Medicaid and other social welfare programs in the 1960s helped spur a large-scale relocation of patients to community-based mental health centers. In 1964, the Department of Mental Health was created as an independent agency to assist the state with research, mental health education, professional training, along with other community services.
By the end of the 1970s, patient’s rights became a key role in the in the renewed emphasis on caring for the mentally ill. In 1985, a U.S. Department of Justice report noted that conditions at the asylum were “flagrantly unconstitutional.” The Justice Department entered into a four-year decree to provide increased funding for all patients at the state hospital. Slowly wards were being closed by the 1990s. Soon entire floors were abandoned, as patients were discharged to group homes or local care facilities.